MEDICARE: DR. TAN VU D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	17170	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17170	OTHER	TX	LICENSE NUMBER
2	481151	OTHER	TX	UNITED CONCORDIA ID

General Provider Information

NPI Number	:	1750500617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAN VU D.D.S

Provider Business Mailing Address
First Line	:	9798 BELLAIRE BLVD
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77036-3427
Country	:	US
Telephone Number	:	713-541-9007
Fax Number	:	713-988-3620

Provider Business Practice Location Address
First Line	:	9798 BELLAIRE BLVD
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77036-3427
Country	:	US
Telephone Number	:	713-541-9007
Fax Number	:	713-988-3620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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